International Journal of Pediatrics
Volume:10 Issue: 108, Dec 2022

During the two years of COVID-19 lockdown and its related restrictions, the level of physical activity has decreased among children. Considering the adverse effects of insufficient physical activity (PA) on the health of children and adolescents, this study was conducted with the aim of investigating the level of physical activity during the COVID-19 pandemic among children and adolescents aged 8-19 years, in Iran.

This cross-sectional study was conducted among 16,500 urban and rural students 8-19 year-old from 31 provinces across the country, during the COVID-19 pandemic in Iran. Multistage sampling was used to select the participants. Data was gathered in January 2022 using the Persian version of the PA Questionnaire (PAQ) for older children and adolescents, based on the WHO- Global School-based Student Health Survey (GSHS) questionnaire.

14893 cases were included in the study. The result of this study showed that more than half of the participants had a medium level of PA, and 32.5 had a low level of PA and only 12.6% of the participants had a high level of PA. Males and those in the age group of 14 to 19 years had significantly higher levels of PA (P<0.05). The regression analysis showed that for a one-year increase in age, the PA score would decrease by 0.256 times (p=0.000). The mean PAQ score was significantly higher among children whose parents did not have a health-related occupation or were unemployed.

Although the finding of this study showed controversial results considering the decrease in children’s PA scores during the COVID-19 pandemic, it demonstrated a low PA level among Iranian children in general.

Management of dental anxiety and fear of pediatric dental patients is a major goal in pediatric dentistry to create a positive attitude towards dental procedures and perform a successful treatment. Preoperative positive imagery and distraction during treatment are some of the non-pharmaceutical approaches for reduction of fear and anxiety of pediatric dental patients. This study aimed to compare the efficacy of dental simulation game applications (apps) in smartphones and virtual reality glasses on the management of dental anxiety and fear in 5-8-year-old dental patients.

This randomized clinical trial was conducted on 42 eligible children between 5-8 years in their first dental visit. After prophylaxis and fluoride therapy, patients were randomly assigned to two groups (n=21). Group 1 used Virtual reality glasses during the procedure while group 2 used dental simulation game apps prior to treatment. After completion of dental procedure, dental anxiety and fear of children were recorded in both groups using the Facial Image Scale (FIS) and Modified Child Dental Anxiety Scale (MCDAS); and the results were compared by t-test and Mann-Whitney test (alpha=0.05).

The FIS scores were not significantly different between the groups (P=0.068). However, the MCDAS scores showed significantly lower levels of dental anxiety and fear in the VR group compared with the app group (P=0.002).

Wearing Virtual reality glasses operating based on the distraction technique during dental procedures was more effective than preoperative use of dental simulation game apps for reduction of dental anxiety and fear of 5-8-year-old children.

In recent years, there has been a sharp rise in the prevalence of obesity across all age groups, which poses a serious threat to public health. Numerous micronutrients, including magnesium, are deficient in obese people. Magnesium is a vital cofactor for hundreds of enzyme systems and is involved in the metabolism of sugars, proteins, and lipids. Obesity is one of the most significant risk factors associated with the development of glucose intolerance, cardiovascular disease, high blood pressure, and hyperlipidemia. Given the recent rise in obesity at young ages, this study aimed at comparing serum magnesium and blood sugar levels between obese and normal-weight adolescents.

In this case-control study, fifty-seven 12-18-year-old obese and overweight adolescents (BMI above 85% as the case group) and normal-weight adolescents (BMI between 65% and 85% as the control group) were selected randomly from high schools across Birjand. Upon recruitment and assignment of participants, blood samples were collected and serum magnesium and glucose levels were measured. SPSS 15 software was utilized to analyze the collected data.

Age and gender distributions were similar between the case and control groups (P> 0.05). The mean serum magnesium concentration was significantly lower in the case group than in the control group (P <0.05). The mean blood sugar level in the case group was significantly higher than that in the control group (P <0.05). There was no correlation between blood glucose and magnesium in the two groups (P> 0.05).

The mean serum magnesium concentration of overweight and obese adolescents is lower than that of normal-weight children. Therefore, serum Mg may serve as an early biomarker for predicting obesity-related diseases. Further research is required to evaluate the precise role of magnesium in obesity prevention and to establish the causal relationship between obesity and magnesium deficiency.

Diabetes mellitus Type I is the most common childhood metabolic disorder. There is evidence indicating that diabetics have different salivary flow and salivary compositions, as compared to non-diabetic individuals. This study investigated salivary flow and unstimulated salivary pH of Type I diabetics aged 6-16 years in comparison to the controls.

This analytical cross-sectional study was conducted on 120 children. Thirty children with Type I diabetes and ninety children as controls were matched with the diabetic group in terms of age and gender. Unstimulated salivary flow was collected by spitting method for 10 minutes and saliva pH was measured using a digital pH-meter. Salivary flow and pH were compared between two groups using chi-square and t-test.

The mean salivary flow of diabetic and non-diabetic children was 0.268±0.168 and 0.454±0.307 mL/min, respectively. The mean pH of saliva of diabetic and non-diabetic children was 7.19±0.611 and 7.37±0.466, respectively. The mean unstimulated salivary flow was lower in diabetic children as compared to non-diabetic pediatric cases, and this difference was statistically significant (P=0.002). Although diabetic children had lower salivary pH compared to their healthy counterparts, the difference between the two was not statistically significant (P=0.10).

Diabetic children had lower mean unstimulated salivary flow, compared to non-diabetic children. Although diabetic children had a lower mean salivary pH than healthy children, this difference was not statistically significant.

The aim of this study was to investigate the efficacy of the low intensity pulsed ultrasound in reconstruction of the alveolar cleft area after autologous bone grafting.

In this study, 14 patients with unilateral or bilateral cleft lip and palate aged between 9 to 13 years, were selected. Seven of the patients received only the autologous bone graft and the remaining seven underwent alveolar bone graft, and one week after transplantation were subjected to LIPUS waves for five minutes at a frequency of 1 MHz and 100 mW in the area of the graft for a period of five weeks (15 sessions). CBCT images were immediately taken after surgery and three months later. In CBCTs, bone mass was measured with two components of height and bone thickness and the quality was measured by evaluating the bone density by means of the Hounsfield Uniform (HU) mean. Data analysis was done via SPSS version 16 software and using paired t, independent t, and Mann-Whitney and Wilcoxon tests. A significance level of 0.05 was considered.

The mean changes of the sagittal thickness (P=.944), sagittal height (P=.482), and axial thickness (P=.242) before and after surgery, in contrast to the axial height (P=.357) and density (P=.443), were less in the control group than the intervention group, but the differences were not significant for any of variables. In the intervention and control groups, in comparison to the immediate results after surgery, the mean values of the sagittal thickness, sagittal height, axial thickness, and axial height decreased significantly three months later; but the mean loss in density was not significant.

Ultrasound in repairing alveolar defect in patients with cleft palate has no significant effect on clinical success criteria.

The prevalence of Coronavirus and COVID-19 disease has had far-reaching effects in various aspects. Considering the importance of a comprehensive study of the disease of Covid-19 and its epidemic, this study was conducted.

This research evaluated COVID-19 in pregnant women and children under 13 years of age in Nahavand City, west of Iran, from March 2020 to March 2021. Information about the epidemiology of COVID-19 disease was extracted from the infectious diseases unit of Nahavand Health Center. Descriptive statistics, chi-square test, and Logistic regression model were used to evaluate the disease. All data of this study were analyzed using SPSS software, version 16. The inclusion condition in this study was having positive RT-PCR. No general vaccination was performed at the time of this study.

22.5% of the children had a positive RT-PCR test. The age group of 12-13 years had the most patients. 36.3% of children needed hospital treatment. Pregnant women comprised 2.08% of the infected population of Nahavand city in the defined time. 6.7% of them were hospitalized. The mean age of the pregnant women was 28.4 years. The mortality rate in both groups was zero.

COVID-19 disease, in pregnant women, was significantly correlated with age, contact with COVID-19, underlying disease and hospitalization. According to the analysis of variance, there was a significant correlation between the disease and age groups in children under 13 years old

Vesicoureteral reflux (VUR) is a high-prevalence and dangerous urinary system disorder. So, this study was performed to investigate the comparison between intermittent and continuous administration of antibiotics for the treatment of children with VUR.

In this study, 27 children with VUR referred to a nephrology clinic were included in the study. Children received cephalexin at 15 mg/kg once a day for 6 months, and after a 48-hour washout period, children received cephalexin at 15 mg/kg intermittently every other day for 6 months. Before the start of each treatment period, kidney and urinary tract ultrasounds and urine tests were performed for patients. In case of fever, dysuria, and frequent urination, urine test and culture were performed immediately, and in case of no symptoms, urine test and culture were performed monthly.

Out of 27 children, 4 children (14.8%) had abnormal dimercaptosuccinic acid (DMSA) results, 18 (66.7%) had bladder reflux grade 4-5, 9 (33.3%) were less than 12 months, and 4 (14.8%) had recurrent urinary tract infections (UTI). The incidences of urinary tract infection did not differ, significantly, in continuous and intermittent antibiotic treatments (p>0.05). There were no ultrasound changes after the treatment period.

There was no difference between intermittent and continuous administrations of antibiotics in the improvement of UTI symptoms in children with VUR. Therefore, the intermittent method can be used as a method with fewer toxicity or adverse effects in the treatment of these patients due to lower doses of antibiotic administration.

Malrotation is an emergency, mainly in pediatric cases, and needs a timely and prompt diagnosis. Upper gastrointestinal (GI) contrast study used to be an acceptable modality in the diagnosis of malrotation; however, it has many disadvantages. In this regard, sonography has tried to take the place of upper GI studies. The aim of our study is to assess sonography and upper GI series as diagnostic methods for malrotation.

In a cross-sectional study, 154 pediatric cases suspected of malrotation were enrolled. The patients underwent upper GI series and sonography. In the case of sonography, two different findings, including inversion of the superior mesenteric vein (SMV) and superior mesenteric artery (SMA) and deviation (abnormal pathway) of the mesenteric artery were assessed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different sonography findings and upper GI study were calculated.

Different sonography findings showed various diagnostic values. Inversion of SMV/SMA had a sensitivity of 58.87%, specificity of 36.17%, PPV of 67.74%, and NPV of 27.86%. Furthermore, the sensitivity, specificity, PPV, and NPV of deviation (abnormal pathway) of mesenteric vessels were 89.87%, 17.02%, 64.54%, and 50%, respectively. Taking into consideration the two findings together, sonography showed a sensitivity of 73.83% and PPV of 67.74%. Moreover, the sensitivity, specificity, PPV, and NPV of upper GI studies were 82.5%, 100%, 100%, and 50%, respectively.

Mesenteric vessel abnormalities may be valuable in detecting malrotation, but still upper GI contrast study is better. Development of other sonographic markers of malrotation, especially for different ages, is necessary.

The prevalence of celiac disease, which is gastrointestinal enteropathy, is increasing. This study aimed to assess the clinical presentations of celiac disease in children.
The current research is a descriptive-cross-sectional study conducted on 200 children with celiac disease who presented to the gastroenterology clinic of Ghaem Hospital. All patients with celiac disease, presented between 2016 and 2021 were included. For all patients, a checklist including demographic information such as age, sex, weight, weight Z score, height, height Z score, the initial clinical presentations leading to the diagnosis, laboratory examinations including CBC, Anti-TTG IgA, as well as pathological findings including biopsy, and Marsh score were recorded. Subsequently, the findings were described using the frequency table.
Out of 200 children examined, 65.5% were girls, and 34.5% were boys. The average age of the patients was 7.70±3.71 years. The most common clinical presentations were: growth failure (38.5%), diabetes (21%), and abdominal pain (15.5%). The average Anti TTG (IgA) level of the patients in the study was 202.03, with a standard deviation of 146.05. Also, the weight z score for the age of the studied subjects varied between 64 and 147, and its average was 2.06 with a standard deviation of 10.85. The height Z score for age ranged between 6 and 6.7, with the average was 0.87, and a standard deviation of 1.63.
In the current study, growth failure was the most common clinical presentation. As children with celiac disease do not always have the typical presentations such as diarrhea, abdominal pain, steatorrhea, and bloating, it is recommended that the atypical presentations be also noted, particularly growth failure.

The term "athlete’s heart" is used to describe physiological changes occurring in the heart of a sportsperson. In contrast to young athletes, there is little data on the physiological changes in children during sport activities. The present study was conducted to compare tissue Doppler echocardiographic indices in adolescent athletes and controls.
In a case-control study done in Mashhad, Iran in 2018, 60 male adolescent athletes and 60 healthy individuals as controls were entered. All subjects were examined by a pediatric cardiologist using echocardiography to compare tissue Doppler Echocardiographic indices between case and control groups. Data analysis was done Using SPSS.20 .The significance level was<5%.
Age, weight, height, heart rate and fractional shortening at baseline were not different between the two groups. In the athletes group, Ejection fraction (EF) was greater compared to the control group, while Systolic Blood Pressure (SBP) and Body Mass Index (BMI) were lower. Univariate analysis of Mitral waves showed that athletes presented greater A, E and E/E` ratio than controls and  E` and S are greater in controls than in athletes. In relation to septal waves, only E` was higher in controls. In relation to tricuspid waves A, E, E`/A`ratio and E/E` ratio were higher in athletes as compared to the controls.
As a useful imaging tool, echocardiography can be employed to detect underlying heart disorders that may threaten people who exercise. However, better identification of individuals at risk of heart attack or other irreversible cardiac damages requires greater knowledge of the pathophysiology of cardiac adaptation to training.

character strengths show a person's assets over his/her faults or problems, so they are also called personal assets. This study aimed to investigate the role of strength-based parenting moderators in the relationship between character strength and psychological well-being.
The research design was correlational. The statistical population included all sixth-grade students in the 18th district of Tehran in 2019-2020, which comprised 300 sixth-grade students who were selected through a stratified cluster random sampling method. Students completed the Values in Action Inventory of Strengths (VIA-IS), Ryff's scale of Psychological well-being, short-form (18-item), Strengths Use Questionnaire, and Parent-Child Relationship Questionnaire (PCRS). Descriptive statistics, correlation matrix, and hierarchical regression were performed through SPSS statistical software, version 25.
The demographic characteristics of the sample showed that 54% of the sample were firstborn, 35% were second-born and 9.7% were third-born. The findings revealed that there is a positive and significant relationship between character strength and psychological well-being (P <0.01). The results also illuminated that strength-based parenting has a moderating effect on the relationship between character strength and psychological well-being in children (P <0.01). In total, 55% of changes in psychological well-being were explained by the strength of character and strength-based parenting.
According to the research findings, it can be concluded that strength-based parenting will change the strength of character and psychological well-being of students.

Providing high-quality medical services and training future specialists is one of the most vital tasks of the medical education system but there is still no agreement on the best strategy for selecting the most competent candidates in the future. This study aimed to review studies on the currently used criteria. 

In this systematized review, the research question was “What are the criteria for selecting pediatric residents in medical universities?" PubMed, Scopus and ISI databases were searched electronically on March 23, 2022 with the defined strategies, based on which 624 articles were retrieved. After omitting duplicates along with title and abstract screening, 72 remaining full papers were studied and the results were extracted from 17 eligible articles.

Based on the review, 11 criteria and tools were identified; they includes: Structured Interview (SI), Letter of Recommendation (LoR), Multiple Mini-Interview (MMI), P-Mex, Assessment Letter for Pediatrics (ALPs), Situational Judgment Test (SJT), Scholar activities, Global assessment, Competency-based assessment center, University grades, and USMLE scores.

The findings suggested that it is necessary to determine a valid and reliable framework to assess the expected competencies and specific tasks including cognitive and non-cognitive qualities that predict successful future performance.

Although the impact of physical activity on controlling or reducing obesity has been well documented, the components that can affect this relationship have not been well defined. Hence, the current study aimed at examining the relationship between physical activity and adiposity in children with a consideration of self-esteem and body-image as mediators.

This study followed a descriptive-correlational design. In Total, 384 children (average age of 7.67 ± 0.82 years) from Gorgan, Iran, in 2022 participated in this study. Physical Activity Behavior in Leisure-Time Scale, Rosenberg Self-Esteem Scale, and Multidimensional Body-Self Relations Questionnaire–Appearance Scales were used for assessing Physical activity, self-esteem, and body-image, respectively. BMI was calculated for assessing adiposity. Structural equation modeling was implemented for analyzing the collected data.

Our sample had relatively low levels of physical activity and boys had higher levels of physical activity than girls (3.48 vs. 2.04 days/weeks, respectively, t=5.79, P<0.001). Physical activity had inversely affected BMI (T=-7.769). Moreover, Physical activity positively affected self-esteem (T=6.967) and body-image (T=4.740). Finally, self-esteem and body-image significantly mediated the association between physical activity and BMI (P<0.001).

Overall, self-esteem and body-image can be considered as psychological predictors of obesity. In addition, physical activity and obesity are critical concerns about children. Accordingly, it is necessary to adopt appropriate strategies for enhancing active lifestyle among this population.

Coronavirus disease (COVID- 19) is affecting millions of people around the world. It is mainly associated with respiratory problems, but extra pulmonary involvement has been described as well (1). During the COVID-19 outbreak, several children developed a severe inflammatory disease, named Multisystem Inflammatory Syndrome (MIS-C). Acute MISC can have life-threatening consequences and requires intensive medical care. It is not known how long-term the results of acute MISC are.  Liver damage, gastrointestinal, endocrine and cardiovascular disorders have been detected [2]. The aim of this article is to consider complications of MIS-C in patients with abdominal pain, due to the fact that despite abdominal pain is also a symptom of MIS-C, it should not distract us from rare complications such as splenic abscess, which as a differential diagnosis can be fatal if left untreated. Herein, we report a COVID-19 patient with no signs of respiratory involvement presented with acute abdomen, and splenic abscess which was seen on the CT-scan later.

Partial trisomy 9q is a rare condition and the newborns have a chance to survive. Depending on the size and location of the duplicated segment, clinical signs and symptoms are varied. We report a novel chromosomal rearrangement in a 3-day-old female with some general facial abnormalities.

High resolution karyotyping in peripheral blood with the G-banding method was performed.

The method revealed 46,XX,der(5)t(5;9)(p15.3;q34.1),dup(9)(q33q12). This suggested a complete duplication of the long arm of chromosome 9. There was an inverted duplication of the q arm of chromosome 9 with a translocation between the long arm of chromosome 9 and the short arm of chromosome 5. The newborn had a diagnosis of Hirschsprung’s disease.

The karyotyping revealed a novel chromosomal rearrangement. The partial trisomy 9q in conjunction with Hirschsprung’s disease has not been reported. This condition may be due to a complete duplication of chromosome 9q or a translocation with chromosome 5p. The facial abnormalities may be diagnosed in the clinic and genetic counseling. A patient with hirschsprung’s disease and craniofacial abnormalities should be evaluated for partial trisomy 9q.

Case Report: 

A 2-year-old girl was referred with the chief complaint of limb weakness following a mild trauma. She had been suffering from restlessness and neck pain for a month. Laboratory findings were normal. In MRI, there was evidence of craniocervical junction extra-axial mass lesion arising from the posterior aspect of the dense process ligamentous complex extending from the foramen magnum to the posterior fossa with engulfment of the right vertebral artery. Regarding the compressive effect of the tumor, a right trans-condylar suboccipital surgical approach was used to resection the mass, near totally, and decompress the brain stem. Immune-Histo-Chemical Staining (IHC) showed a grade 2 meningioma. Low-dose radiotherapy was applied; but the pathology result corroborated the tumor’s radiologic features. Due to the follow-up MRI evidence of aggressive tumor recurrence the clinical behavior of the tumor and the patient's progression, there was a possibility that the first diagnosis was not correct; hence, a second operation was performed during which a smaller portion of the tumor could be resected compared with the first operation. Pathological study and IHC staining reported MRT and tumor markers, including pan-cytokeratin (CK), epithelial membrane antigen (EMA), and vimentin, were strongly positive. So, a chemotherapy regimen was added to radiotherapy. Unfortunately, the patient did not respond well to the follow-up treatment, and she expired after one year.

In similar cases, where the radiological and pathological features of the tumor are atypical, the histological examination should include molecular examination, as meningioma in this age group is extremely rare. And, confirming the pathological and molecular characteristics of the tumor by different experts is strongly recommended.